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Outside The Office | November 2018

Cardio and Cataract Surgery

Exercise can increase mental and physical capacity for long days in the OR.

Growing up, I always enjoyed exercise and physical fitness, whether it was through organized sports or other extracurricular activities. However, in my college years, I could not seem to find the time to keep myself in shape, and I fell off the wagon in terms of exercise. When I started doing ophthalmic surgery in residency, I began to notice that, while operating on patients, my neck would get sore and pain would radiate from my back down the back of my leg. At that point, I decided it was time to change.

The effects of physical pain can be far-reaching—pain alters our moods, our mindsets, and our performance in the OR. Physicians are responsible for their patients’ health, but they should also be responsible for their own. Getting myself into better shape has not only benefitted me personally, in terms of overall health and wellness, but it has also improved how I perform surgery. I have increased my physical capacity for spending days in the OR. Routine exercise has helped me to become a better surgeon, and I encourage my colleagues to follow a diet and exercise plan for themselves. (To learn more about dieting, see Nutrition Plays a Role).

TOO MUCH TOO SOON

After residency, I started a pretty vigorous weight training program; I even hired a personal trainer. Unfortunately, I overexerted myself and ended up developing rhabdomyolysis, a condition in which damaged skeletal muscle tissue rapidly breaks down. After that experience, which left me hospitalized for a week, I decided to take a more measured approach to exercise. That is what I have been focusing on for the past 4 or 5 years.

Nutrition Plays a Role

A healthy diet can increase your energy, stamina, and overall wellness, much like an exercise regimen. I have switched to a mostly plant-based diet over the past 4 or 5 years. Although I enjoy eating meat, data show that plant-based nutrition is the best overall diet—and better for the planet.

I also believe that intermittent fasting is a useful tool to use to reduce our overall insulin sensitivity. Using this technique, I eat only during a selected 8-hour time period, and I fast for the remainder of the day. When we eat throughout the day, we fall into a cycle that can actually make us feel more hungry, so we eat more than we need to, and we gain weight (or struggle to lose weight). Believe it or not, fasting this way may actually reduce your overall hunger.

To anyone who is considering getting into shape (or back into shape), I strongly recommend that you should not push yourself too hard. You should have a slow ramp-up phase that lasts at least 4 weeks before you start testing your limits. In other words, do not expect to go back to the gym and start benching what you did 10, 20, or 30 years ago; it is not going to end well. Lift lighter weights with more repetitions, and listen to your body. If you are sore from a particular exercise, do not work that muscle again until the soreness goes away. Try to be strategic about when and how you exercise your body. (For an example of a beginner’s workout plan, see Where to Start).

My overall strategy is to mix high-intensity training, cardiovascular exercise, and weight training. I also participate in group fitness activities such as CrossFit, and I have found that to be inspiring, motivating, and—maybe most important—fun.

REAPING THE BENEFITS

In addition to keeping me fit, exercise is also a great source of stress relief for me. I almost always work out after I have been in the OR. I typically operate 3 days per week, and then I work out before I go home. I think of it like this: The exercise builds extra capacity of mental and physical strength after a full day of performing surgery. Because of this, I have that extra capacity if a surgery day runs long or a case requires extra concentration. I strategically exercise for at least 1 hour after each surgery day.

I try to do a comprehensive full-body workout focusing on my back and lower body. This strategy has not just reduced my neck and back pain, it has completely eliminated it. I perform a lot more surgery than I did several years ago. Although surgical demand would likely have increased regardless of my health, I can now keep up with the higher workload without the pain that I used to experience daily in the OR.

Where to Start

I recently encouraged my son to start working out, and I have him performing three basic exercises that have shown remarkable results. If you do nothing else, consider purchasing a suspension training system and a set of kettle bells. These systems are designed to be compact and easy to use in your own home. With this relatively inexpensive equipment, you can do many different exercises, targeting every major muscle group, without leaving your house.

An important guideline for beginners is to focus on lower weights and higher repetitions. In other words, only use weights that you can lift at least 15 times in a row. As you slowly build strength, you can continue adding weight, but do so slowly.

We inevitably lose muscle mass as we age. Therefore, my goal is to increase my muscle mass as much as I can in order to fight osteopetrosis and other problems down the road. I want to operate until I am 70 years old, so I need to focus on what I can do today to foster the longevity of my career.

THE WORKOUT PLAN

A lot of people use the excuse that they can’t find the time for any form of exercise. I find that convenience plays a vital role in one’s willingness to adhere to a workout plan. I have an exercise bike, treadmill, and set of weights in my basement. If I want to exercise, I can do so at any moment without leaving my house. I can also walk to my gym, which is directly across the street from my office. The close proximity makes it much easier to find the time, and it makes a huge difference.

It is important to remember that physical fitness is not only about the cosmetic effects one might see after a short 90-day program. Instead, I encourage people to think about their fitness program as a 1-, 2-, or 3-year program. Do not worry so much about instant results, but rather your long-term health. For cataract and refractive surgeons, this could add years to the length of your career.

Gary Wörtz, MD
  • Private practice, Commonwealth Eye Surgery, Lexington, Kentucky
  • Founder and Chief Medical Officer, Omega Ophthalmics, Lexington, Kentucky
  • Member, CRST Editorial Advisory Board
  • garywortzmd@gmail.com
  • Financial disclosure: None
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